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. Author manuscript; available in PMC: 2007 Nov 11.
Published in final edited form as: Clin Gastroenterol Hepatol. 2007 Oct;5(10):1126–1122. doi: 10.1016/j.cgh.2007.06.013

Figure 4.

Figure 4

Narcotic Withdrawal Protocol for NBS. After identification of NBS and discussion with the patient (validating pain, discussion of pathophysiology and willingness to start therapy) the taper starts with a hypothetical dosage of 250 mg/day and then weaned at a 10–33% reduction rate per day. Polyethylene glycol (PEG) is used to treat constipation as needed. A tricyclic or serotonin-norepinephrine (SNRI) antidepressant is started before detoxification and continues indefinitely for pain control. Lorazepam added at the outset of therapy for withdrawal anxiety and is discontinued at the end of the narcotic taper. Clonidine is typically added after day 2 or 3 and is continued until withdrawal is completed or for several weeks later. Of paramount importance is an ongoing physician-patient relationship.